Provider Demographics
NPI:1689629990
Name:VALLEY OAKS HEALTH INC
Entity Type:Organization
Organization Name:VALLEY OAKS HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:GILLIOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-446-6535
Mailing Address - Street 1:415 N 26TH STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2856
Mailing Address - Country:US
Mailing Address - Phone:765-446-6535
Mailing Address - Fax:765-446-6536
Practice Address - Street 1:415 N 26TH STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2856
Practice Address - Country:US
Practice Address - Phone:765-446-6535
Practice Address - Fax:765-446-6536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN940740Medicare ID - Type Unspecified